While arthroscopic surgery involving the knee has been practiced for quite some time, arthroscopic surgery on other joints, such as the shoulder, is a relatively new endeavor. A number of problems are encountered in such surgery that are not encountered in arthroscopic surgery of the knee. These problems include working through a thicker layer of skin and muscle tissue than is found in the knee. Other problems include reattaching torn tendons, ligaments, or muscle tissue to bone and the problem of having to work in close proximity to neurovascular structures.
Thus, with such problems, there arises a need for instruments designed to be insertable through a small incision, yet able to reach a remote location at which the repair is to be performed. For example, with the recent advent of arthroscopic surgery to the shoulder, such as in the repair of torn rotator cuff tendons, a new set of instruments and procedures is helpful. As part of the procedure disclosed in the '132 application, a channel (or tunnel) is to be formed in the greater tuberosity of the humerus (shoulder). The traditional method of performing such surgery involves open surgery requiring a large longitudinal wound across the operation site, working through the muscles and exposing the injured tendon. Arthroscopic surgery is preferred, however, especially in view of the quicker recovery time and lessened trauma to the patient. However, arthroscopic surgery requires instruments having a low profile, which are capable of being partially inserted through small incisions in the patient to perform a variety of functions at the operation site located remotely within the patient's body.
In repairing a torn rotator cuff, a channel or tunnel is created through the bone through which suture material can be passed. Presently, such a method of creating a channel employs a pick-type device located at the distal end of a rod. However, problems involved with a pick include the inability to determine exactly where it will emerge when forced through the bone. The "pick method" of creating a channel is, at best, a method of estimating the radius of curvature of the channel and the ultimate end point of the channel where it emerges through the surface of the bone.
What is needed is a device for locating both end points and creating a channel of predetermined radius of curvature between those twin points that can be inserted through a small puncture wound for arthroscopic use. The device of the present invention provides for just such an instrument. More specifically, the device of the present invention provides for a low profile compound lever awl with a pair of semicircular pincer jaws. The use of such a tool allows for a low profile and therefore ease of insertion into the patient, as through a cannula, while also providing for a device to locate and fix the end points of the channel to be created and to positively determine the path of such a channel between the end points.